Arch Plast Surg.  2017 May;44(3):202-209. 10.5999/aps.2017.44.3.202.

Long-Term Follow-Up Study of Young Adults Treated for Unilateral Complete Cleft Lip, Alveolus, and Palate by a Treatment Protocol Including Two-Stage Palatoplasty: Speech Outcomes

• Kappen IF
• Bittermann D
• Janssen L
• Bittermann GKP
• Boonacker
• Haverkamp
• de Wilde H
• Van Der Heul M
• Specken TF
• Koole R
• Kon M
• Breugem CC
• Mink van der Molen AB

• KMID: 2403913
• DOI: http://doi.org/10.5999/aps.2017.44.3.202

Abstract

BACKGROUND
No consensus exists on the optimal treatment protocol for orofacial clefts or the optimal timing of cleft palate closure. This study investigated factors influencing speech outcomes after two-stage palate repair in adults with a non-syndromal complete unilateral cleft lip and palate (UCLP).
METHODS
This was a retrospective analysis of adult patients with a UCLP who underwent two-stage palate closure and were treated at our tertiary cleft centre. Patients ≥17 years of age were invited for a final speech assessment. Their medical history was obtained from their medical files, and speech outcomes were assessed by a speech pathologist during the follow-up consultation.
RESULTS
Forty-eight patients were included in the analysis, with a mean age of 21 years (standard deviation, 3.4 years). Their mean age at the time of hard and soft palate closure was 3 years and 8.0 months, respectively. In 40% of the patients, a pharyngoplasty was performed. On a 5-point intelligibility scale, 84.4% received a score of 1 or 2; meaning that their speech was intelligible. We observed a significant correlation between intelligibility scores and the incidence of articulation errors (P<0.001). In total, 36% showed mild to moderate hypernasality during the speech assessment, and 11%-17% of the patients exhibited increased nasalance scores, assessed through nasometry.
CONCLUSIONS
The present study describes long-term speech outcomes after two-stage palatoplasty with hard palate closure at a mean age of 3 years old. We observed moderate long-term intelligibility scores, a relatively high incidence of persistent hypernasality, and a high pharyngoplasty incidence.

Keyword

Cleft lip with or without cleft palate, nonsyndromic; Cleft lip; Cleft palate; Adult; Speech

MeSH Terms

Adult
Cleft Lip*
Cleft Palate
Clinical Protocols*
Consensus
Follow-Up Studies*
Humans
Incidence
Palate*
Palate, Hard
Palate, Soft
Retrospective Studies
Young Adult*